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Predictors of pneumonia in acute stroke inpatients in emergency unit
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Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
Background: Cortical deafness is a very rare condition characterized by the complete disruption of central auditory processing with intact peripheral auditory function. Objective: To describe a case of cortical deafness associated with ischemic cerebrovascular disease. Patients and methods: A 61 year-old female with a history of arterial hypertension presented to our department complaining of a sudden complete hearing loss. On examination, she was alert but slightly confused and agitated. Her spontaneous speech was fluent with occasional paraphasic errors. She was unable to follow verbal commands, but could understand simple written information. She appeared totally deaf, with no startle response to loud sounds. The rest of the neurological examination was unremarkable. Brain CT scan demonstrated a chronic right temporoparietal ischemic infarct. Otologic examination revealed no evidence of external or middle ear disease. Audiometry showed normal middle ear reflexes. Brainstem auditory evoked potentials were normal, consistent with normal auditory processing up to and including the inferior colliculi. An MRI scan demonstrated the old right temporoparietal infarct and an additional hyperacute ischemic infarct in the left posterior parietal area, extending into the Heschl's gyrus, the superior temporal gyrus and the Sylvian fissure. In three months' follow-up, the patient showed no improvement and she was able to communicate only through reading and writing. Conclusion: Our case emphasizes on cortical deafness as a rare sole manifestation of ischemic cerebrovascular disease associated with bilateral damage of the primary auditory cortex. doi:10.1016/j.jns.2013.07.920
Abstract — WCN 2013 No: 1900 Topic: 3 — Stroke Central obesity in the poorest region in Chile R.J. Rivasa,b, C.A. Klappb,c, C.A. Darochb,d, H.M. Vásquezb,d. a Neurology Department, Universidad de La Frontera, Chile; bStroke Unit, Clínica Alemana de Temuco, Temuco, Chile; cNeurology Department, Clínica Alemana de Temuco, Temuco, Chile; dNutrition Department, Clínica Alemana de Temuco, Temuco, Chile Background: Stroke is the first most common specific cause of death in Chile, since 2008. The increased risk in our region is explained by the prevalence of poverty, diabetes, a sedentary lifestyle and overweight. Object: Is to assess the waist circumference (WC) in Clínica Alemana Temuco, during January 2011 to March 2013, in patients with a stroke. Methods: We evaluated patients with a stroke diagnosis, in our primary Stroke Unit, who were hospitalized for ≥72 h. Waist circumference (WC) was measured according to WHO's recommendations, by two nutritionists. The study patients were divided into 3 groups according to WC for cardiovascular risk, low risk (LR): b94 cm (men); b80 cm (women); moderate risk (MR): 94–102 cm (men); 80–88 cm (women); and high risk (HR): N102 cm (men); N88 cm (women). We obtained a diagnosis of central obesity (CO) using NCEP-ATP-III criteria. Results: 81 patients were included. 48 were males (59.3%). Men mean aged: 62 years (32–89), mean WC: 103.9 (SD: ±9.9). BMI: 29. LR: 14.6%, MR: 37.5%, HR: 47.9% (CO). Women mean age: 57.4 years (35–81). Mean WC: 102.3 (SD: ±13.6), BMI: 29.9. LR: 3%; MR: 15.2%; HR: 81.8% (CO). Total sample corresponds to LR: 9.9%, MR: 28.4%; and HR: 61.7% (CO). Conclusion: Central obesity is a major risk factor for cardiovascular disease. This series of cases only shows that the problem is very important in Chile. The obesity and central obesity are epidemic. We
should perform behaviors to lower these indicators, with much education and government guidelines. doi:10.1016/j.jns.2013.07.921
Abstract — WCN 2013 No: 2198 Topic: 3 — Stroke Preliminary evaluation of diffusion kurtosis imaging in acute stroke patients Y.-L. Guoa, S.-J. Lia, P. Zhe Sunb, R.-H. Wua. aDepartment of Radiology, The Second Affiliated Hospital, Shantou University Medical College, Shantou, China; bAthinoula A. Martinos Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Aims: To translate and evaluate diffusion kurtosis imaging (DKI) in stroke patients. Methods: Four patients underwent DKI and conventional MRI (including T1WI, T2WI, FLAIR and DWI) using a GE 1.5T HDx echo speed plus an MRI scanner. Mean kurtosis (MK), radial kurtosis (Kr) and axial kurtosis (Ka) were derived using DKI software in GE ADW4.3 workstation. Fourteen regions of interest (ROI) were outlined in infarction regions of stroke patients, including 2 ROIs in super-acute, 3 ROIs in acute, 6 ROIs in subacute and 3 ROIs in chronic lesions. The stroke duration was determined from onset time and DWI signal intensity. Stroke prognosis was evaluated by follow-up MRI and clinical manifestations. Results: During super-acute stroke, regions of hyperintensive MK and Kr progressed to infarction with mild bleeding without noticeable DWI and ADC abnormalities. For the case of sub-acute stroke, DKI (MK and Kr) appeared hypointensive without significant change in DWI and ADC maps. In addition, 10 ROIs showed abnormality in both DKI and DWI/ADC maps. Conclusions: DKI displayed contrast different from the standard DWI and ADC maps. DKI remains promising to address false negative signals in the standard DWI and ADC maps, and complement existing stroke MRI for improved stroke diagnosis. doi:10.1016/j.jns.2013.07.922
Abstract — WCN 2013 No: 2301 Topic: 3 — Stroke Predictors of pneumonia in acute stroke inpatients in emergency unit S.R. Almeidaa, M. Bahiab, F.O. Limab, T.A.M.O. Cardosoa, I. Paschoalc, L.M. Lia, Neurovascular Disease. a Neurology, University of Campinas, UNICAMP, Campinas, Brazil; b Medical Pathophysiology Department, University of Campinas, UNICAMP, Campinas, Brazil; cMedical Clinic, University of Campinas, UNICAMP, Campinas, Brazil Background: Pneumonia is a serious complication in acute stroke patients. Several mechanisms might be implicated including impairment of the immune system and aspiration. The analyses of clinical predictors are useful to guide the clinical management and to adopt preventive measures in order to improve the patients' outcome. Objective: To determine the independent predictors of pneumonia in patients with acute stroke. Methods: This is a retrospective study from July to December 2011. All patients admitted with a diagnosis of stroke in an academic medical center were included. We review all the medical charts and
Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
extracted information using a structured questionnaire, including the demographics, NIH and Glasgow Coma scales; risk factors (hypertension, diabetes, dyslipidemia, smoking, alcohol, previous vascular disease); type (ischemic vs. hemorrhagic) and localization of stroke (anterior vs. posterior circulation); motor deficit; time use of mechanical ventilation. Pneumonia was defined clinically and treated with antibiotics. Results: One hundred and fifty nine patients aged 18 to 90 (mean 63 ± 13.5) years were admitted. Incidence of pneumonia was 32.1%. Pneumonia incidence was higher in patients with ischemic stroke (OR: 4.36, 95% CI: 1.9–10.0). Pneumonia was most common in those with higher NIH and lower Glasgow coma scales (p b 0.0001). Patients with pneumonia had longer hospitalization (p b 0.0001). Logistic regression analyses identified only the NIH stroke scale as an independent predictor of pneumonia (p = 0.001). Conclusion: The severity of the deficit as evaluated by the NIHS scale was shown to be the only independent risk factor for pneumonia in acute stroke patients. doi:10.1016/j.jns.2013.07.923
Abstract — WCN 2013 No: 2318 Topic: 3 — Stroke New prognostic score for the prediction of 30-day outcome in spontaneous supratentorial cerebral hemorrhage L. Csibaa, I. Szélla, R. Szepesia, L. Lánczib, E. Berényib, K. Nagya, D. Bereczkic, L. Kardosd. aNeurology, Debrecen University, Debrecen, Hungary; bBiomedical Laboratory and Imaging Science, Debrecen University, Debrecen, Hungary; cNeurology, Semmelweis University Faculty of Medicine, Budapest, Hungary; dIndependent Statistician, ANTSZ, Debrecen, Hungary Objectives: The purpose of the present study was to evaluate predictors of outcome in primary supratentorial cerebral hemorrhage. Furthermore, we aimed to develop a prognostic model to predict 30-day fatality. Methods: We retrospectively analyzed a database of 156 patients with spontaneous supratentorial hemorrhage to explore the relationship between anamnestic, clinical and CT characteristics, and fatal outcome within 30 days using multiple logistic regression analysis. The analyzed factors included volumetric data assessed by neuropathological and CT volumetry. A second CT scan in survivors, or neuropathological ABC/2 volumetry in non-survivors was used along with the baseline CT to assess the growth index of hematoma. Results: Systolic blood pressure, serum potassium and glucose levels, platelet count, absolute and relative hematoma volumes, presence and size of intraventricular hemorrhage statistically significantly predicted the fatal outcome within 30 days. Based on our results we formulated a six-factor scoring algorithm named SUSPEKT to predict the outcome. Conclusions: After validation the SUSPEKT Score may be applicable in general clinical practice for early patient selection to optimize individual management or for assessment of eligibility for treatment trials. doi:10.1016/j.jns.2013.07.924
Abstract — WCN 2013 No: 2315 Topic: 3 — Stroke Association between metabolic syndrome and homocysteinemia in ischemic stroke M. Vujnica, N. Rasetaa, S. Miljkovicb, D. Racicb, V. Djajicb, O. Perazicc, S. Pericd. aDepartment for Pathophysiology, Faculty of Medicine, University Clinical Center in Banja Luka, Bosnia and Herzegovina;
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b
Neurology Clinic, University Clinical Center in Banja Luka, Bosnia and Herzegovina; cInstitute for Occupational and Sport Medicine of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina; dNeurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia Background: Stroke is one of the leading causes of morbidity and mortality worldwide. The role of metabolic syndrome and homocysteinemia as risk factors for ischemic stroke is not completely clear. Aim: To determine the frequency of metabolic syndrome and homocysteinemia, as well as their association in patients with ischemic stroke. Method: The research included 53 subjects being on rehabilitation after stroke and 40 clinical controls without vascular disease that were on rehabilitation due to the back pain problems. Results: The frequency of metabolic syndrome was much higher in patients with stroke compared to control group (88.7% vs. 70.0%, p b 0.05). The level of homocysteinemia and the frequency of hyperhomocysteinemia were increased in the patients with stroke (15.0 ± 5.50 μmol/L vs. 11.2 ± 2.51 μmol/L, p b 0.01 and 39.2% vs. 11.4%, p b 0.01, respectively). Among patients with stroke, those with metabolic syndrome had higher frequency of hyperhomocysteinemia (42.2% vs. 16.7%, p b 0.05) and the serum level of homocysteine was significantly higher in patients with more individual components of metabolic syndrome (11.1% in patients with 3 components, 36.8% in patients with 4 components and 64.7% in patients with 5 components, p b 0.05). Conclusion: Our results suggest that metabolic syndrome and homocysteinemia represent significant risk factors for ischemic stroke. It seems that there is an association between these two factors in pathogenesis of the ischemic stroke, but further analyses are needed to confirm this hypothesis.
doi:10.1016/j.jns.2013.07.925
Abstract — WCN 2013 No: 2347 Topic: 3 — Stroke Thrombolysis in ischemic stroke in a familial amyloidotic polyneuropathy patient — Is there an increased risk of hemorrhagic complication? S. França, T. Mendonça, E. Azevedo, Grupo de Estudos de Doença Vascular Cerebral Centro Hospitalar de São João, Porto, Portugal Background: Patients with familial amyloidotic polyneuropathy (FAP) type I have typically a severe somatic and autonomic peripheral neuropathy. Amyloid deposits of the mutated transthyretin (frequently TTR Val30-Met, almost all produced by the liver) are said to mostly spare the brain in this type of FAP. Nevertheless, with longer survival induced by liver transplantation the choroid plexus TTR Val30-Met production might become relevant. Patients and methods: A 46-year-old woman with TTR Val30Met FAP, with liver transplant and pacemaker since age 37, and on immunosuppression with tacrolimus, was admitted by acute motor aphasia (NIHSS 4). Brain CT and analytical study were normal. Thrombolysis was started 3.5 h after symptom onset. At the stroke unit she worsened and repeated CT scan disclosing left temporal and right fronto-basal hematoma. Due to pacemaker MRI was not performed. Cervical and transcranial duplex scan was normal. She was discharged a week later asymptomatic, on triflusal 600 mg/d. Discussion: There is no data on thrombolysis safety in FAP patients. It is known that in some mutations there is an important amyloid
Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
Background: Cortical deafness is a very rare condition characterized by the complete disruption of central auditory processing with intact peripheral auditory function. Objective: To describe a case of cortical deafness associated with ischemic cerebrovascular disease. Patients and methods: A 61 year-old female with a history of arterial hypertension presented to our department complaining of a sudden complete hearing loss. On examination, she was alert but slightly confused and agitated. Her spontaneous speech was fluent with occasional paraphasic errors. She was unable to follow verbal commands, but could understand simple written information. She appeared totally deaf, with no startle response to loud sounds. The rest of the neurological examination was unremarkable. Brain CT scan demonstrated a chronic right temporoparietal ischemic infarct. Otologic examination revealed no evidence of external or middle ear disease. Audiometry showed normal middle ear reflexes. Brainstem auditory evoked potentials were normal, consistent with normal auditory processing up to and including the inferior colliculi. An MRI scan demonstrated the old right temporoparietal infarct and an additional hyperacute ischemic infarct in the left posterior parietal area, extending into the Heschl's gyrus, the superior temporal gyrus and the Sylvian fissure. In three months' follow-up, the patient showed no improvement and she was able to communicate only through reading and writing. Conclusion: Our case emphasizes on cortical deafness as a rare sole manifestation of ischemic cerebrovascular disease associated with bilateral damage of the primary auditory cortex. doi:10.1016/j.jns.2013.07.920
Abstract — WCN 2013 No: 1900 Topic: 3 — Stroke Central obesity in the poorest region in Chile R.J. Rivasa,b, C.A. Klappb,c, C.A. Darochb,d, H.M. Vásquezb,d. a Neurology Department, Universidad de La Frontera, Chile; bStroke Unit, Clínica Alemana de Temuco, Temuco, Chile; cNeurology Department, Clínica Alemana de Temuco, Temuco, Chile; dNutrition Department, Clínica Alemana de Temuco, Temuco, Chile Background: Stroke is the first most common specific cause of death in Chile, since 2008. The increased risk in our region is explained by the prevalence of poverty, diabetes, a sedentary lifestyle and overweight. Object: Is to assess the waist circumference (WC) in Clínica Alemana Temuco, during January 2011 to March 2013, in patients with a stroke. Methods: We evaluated patients with a stroke diagnosis, in our primary Stroke Unit, who were hospitalized for ≥72 h. Waist circumference (WC) was measured according to WHO's recommendations, by two nutritionists. The study patients were divided into 3 groups according to WC for cardiovascular risk, low risk (LR): b94 cm (men); b80 cm (women); moderate risk (MR): 94–102 cm (men); 80–88 cm (women); and high risk (HR): N102 cm (men); N88 cm (women). We obtained a diagnosis of central obesity (CO) using NCEP-ATP-III criteria. Results: 81 patients were included. 48 were males (59.3%). Men mean aged: 62 years (32–89), mean WC: 103.9 (SD: ±9.9). BMI: 29. LR: 14.6%, MR: 37.5%, HR: 47.9% (CO). Women mean age: 57.4 years (35–81). Mean WC: 102.3 (SD: ±13.6), BMI: 29.9. LR: 3%; MR: 15.2%; HR: 81.8% (CO). Total sample corresponds to LR: 9.9%, MR: 28.4%; and HR: 61.7% (CO). Conclusion: Central obesity is a major risk factor for cardiovascular disease. This series of cases only shows that the problem is very important in Chile. The obesity and central obesity are epidemic. We
should perform behaviors to lower these indicators, with much education and government guidelines. doi:10.1016/j.jns.2013.07.921
Abstract — WCN 2013 No: 2198 Topic: 3 — Stroke Preliminary evaluation of diffusion kurtosis imaging in acute stroke patients Y.-L. Guoa, S.-J. Lia, P. Zhe Sunb, R.-H. Wua. aDepartment of Radiology, The Second Affiliated Hospital, Shantou University Medical College, Shantou, China; bAthinoula A. Martinos Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Aims: To translate and evaluate diffusion kurtosis imaging (DKI) in stroke patients. Methods: Four patients underwent DKI and conventional MRI (including T1WI, T2WI, FLAIR and DWI) using a GE 1.5T HDx echo speed plus an MRI scanner. Mean kurtosis (MK), radial kurtosis (Kr) and axial kurtosis (Ka) were derived using DKI software in GE ADW4.3 workstation. Fourteen regions of interest (ROI) were outlined in infarction regions of stroke patients, including 2 ROIs in super-acute, 3 ROIs in acute, 6 ROIs in subacute and 3 ROIs in chronic lesions. The stroke duration was determined from onset time and DWI signal intensity. Stroke prognosis was evaluated by follow-up MRI and clinical manifestations. Results: During super-acute stroke, regions of hyperintensive MK and Kr progressed to infarction with mild bleeding without noticeable DWI and ADC abnormalities. For the case of sub-acute stroke, DKI (MK and Kr) appeared hypointensive without significant change in DWI and ADC maps. In addition, 10 ROIs showed abnormality in both DKI and DWI/ADC maps. Conclusions: DKI displayed contrast different from the standard DWI and ADC maps. DKI remains promising to address false negative signals in the standard DWI and ADC maps, and complement existing stroke MRI for improved stroke diagnosis. doi:10.1016/j.jns.2013.07.922
Abstract — WCN 2013 No: 2301 Topic: 3 — Stroke Predictors of pneumonia in acute stroke inpatients in emergency unit S.R. Almeidaa, M. Bahiab, F.O. Limab, T.A.M.O. Cardosoa, I. Paschoalc, L.M. Lia, Neurovascular Disease. a Neurology, University of Campinas, UNICAMP, Campinas, Brazil; b Medical Pathophysiology Department, University of Campinas, UNICAMP, Campinas, Brazil; cMedical Clinic, University of Campinas, UNICAMP, Campinas, Brazil Background: Pneumonia is a serious complication in acute stroke patients. Several mechanisms might be implicated including impairment of the immune system and aspiration. The analyses of clinical predictors are useful to guide the clinical management and to adopt preventive measures in order to improve the patients' outcome. Objective: To determine the independent predictors of pneumonia in patients with acute stroke. Methods: This is a retrospective study from July to December 2011. All patients admitted with a diagnosis of stroke in an academic medical center were included. We review all the medical charts and
Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
extracted information using a structured questionnaire, including the demographics, NIH and Glasgow Coma scales; risk factors (hypertension, diabetes, dyslipidemia, smoking, alcohol, previous vascular disease); type (ischemic vs. hemorrhagic) and localization of stroke (anterior vs. posterior circulation); motor deficit; time use of mechanical ventilation. Pneumonia was defined clinically and treated with antibiotics. Results: One hundred and fifty nine patients aged 18 to 90 (mean 63 ± 13.5) years were admitted. Incidence of pneumonia was 32.1%. Pneumonia incidence was higher in patients with ischemic stroke (OR: 4.36, 95% CI: 1.9–10.0). Pneumonia was most common in those with higher NIH and lower Glasgow coma scales (p b 0.0001). Patients with pneumonia had longer hospitalization (p b 0.0001). Logistic regression analyses identified only the NIH stroke scale as an independent predictor of pneumonia (p = 0.001). Conclusion: The severity of the deficit as evaluated by the NIHS scale was shown to be the only independent risk factor for pneumonia in acute stroke patients. doi:10.1016/j.jns.2013.07.923
Abstract — WCN 2013 No: 2318 Topic: 3 — Stroke New prognostic score for the prediction of 30-day outcome in spontaneous supratentorial cerebral hemorrhage L. Csibaa, I. Szélla, R. Szepesia, L. Lánczib, E. Berényib, K. Nagya, D. Bereczkic, L. Kardosd. aNeurology, Debrecen University, Debrecen, Hungary; bBiomedical Laboratory and Imaging Science, Debrecen University, Debrecen, Hungary; cNeurology, Semmelweis University Faculty of Medicine, Budapest, Hungary; dIndependent Statistician, ANTSZ, Debrecen, Hungary Objectives: The purpose of the present study was to evaluate predictors of outcome in primary supratentorial cerebral hemorrhage. Furthermore, we aimed to develop a prognostic model to predict 30-day fatality. Methods: We retrospectively analyzed a database of 156 patients with spontaneous supratentorial hemorrhage to explore the relationship between anamnestic, clinical and CT characteristics, and fatal outcome within 30 days using multiple logistic regression analysis. The analyzed factors included volumetric data assessed by neuropathological and CT volumetry. A second CT scan in survivors, or neuropathological ABC/2 volumetry in non-survivors was used along with the baseline CT to assess the growth index of hematoma. Results: Systolic blood pressure, serum potassium and glucose levels, platelet count, absolute and relative hematoma volumes, presence and size of intraventricular hemorrhage statistically significantly predicted the fatal outcome within 30 days. Based on our results we formulated a six-factor scoring algorithm named SUSPEKT to predict the outcome. Conclusions: After validation the SUSPEKT Score may be applicable in general clinical practice for early patient selection to optimize individual management or for assessment of eligibility for treatment trials. doi:10.1016/j.jns.2013.07.924
Abstract — WCN 2013 No: 2315 Topic: 3 — Stroke Association between metabolic syndrome and homocysteinemia in ischemic stroke M. Vujnica, N. Rasetaa, S. Miljkovicb, D. Racicb, V. Djajicb, O. Perazicc, S. Pericd. aDepartment for Pathophysiology, Faculty of Medicine, University Clinical Center in Banja Luka, Bosnia and Herzegovina;
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b
Neurology Clinic, University Clinical Center in Banja Luka, Bosnia and Herzegovina; cInstitute for Occupational and Sport Medicine of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina; dNeurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia Background: Stroke is one of the leading causes of morbidity and mortality worldwide. The role of metabolic syndrome and homocysteinemia as risk factors for ischemic stroke is not completely clear. Aim: To determine the frequency of metabolic syndrome and homocysteinemia, as well as their association in patients with ischemic stroke. Method: The research included 53 subjects being on rehabilitation after stroke and 40 clinical controls without vascular disease that were on rehabilitation due to the back pain problems. Results: The frequency of metabolic syndrome was much higher in patients with stroke compared to control group (88.7% vs. 70.0%, p b 0.05). The level of homocysteinemia and the frequency of hyperhomocysteinemia were increased in the patients with stroke (15.0 ± 5.50 μmol/L vs. 11.2 ± 2.51 μmol/L, p b 0.01 and 39.2% vs. 11.4%, p b 0.01, respectively). Among patients with stroke, those with metabolic syndrome had higher frequency of hyperhomocysteinemia (42.2% vs. 16.7%, p b 0.05) and the serum level of homocysteine was significantly higher in patients with more individual components of metabolic syndrome (11.1% in patients with 3 components, 36.8% in patients with 4 components and 64.7% in patients with 5 components, p b 0.05). Conclusion: Our results suggest that metabolic syndrome and homocysteinemia represent significant risk factors for ischemic stroke. It seems that there is an association between these two factors in pathogenesis of the ischemic stroke, but further analyses are needed to confirm this hypothesis.
doi:10.1016/j.jns.2013.07.925
Abstract — WCN 2013 No: 2347 Topic: 3 — Stroke Thrombolysis in ischemic stroke in a familial amyloidotic polyneuropathy patient — Is there an increased risk of hemorrhagic complication? S. França, T. Mendonça, E. Azevedo, Grupo de Estudos de Doença Vascular Cerebral Centro Hospitalar de São João, Porto, Portugal Background: Patients with familial amyloidotic polyneuropathy (FAP) type I have typically a severe somatic and autonomic peripheral neuropathy. Amyloid deposits of the mutated transthyretin (frequently TTR Val30-Met, almost all produced by the liver) are said to mostly spare the brain in this type of FAP. Nevertheless, with longer survival induced by liver transplantation the choroid plexus TTR Val30-Met production might become relevant. Patients and methods: A 46-year-old woman with TTR Val30Met FAP, with liver transplant and pacemaker since age 37, and on immunosuppression with tacrolimus, was admitted by acute motor aphasia (NIHSS 4). Brain CT and analytical study were normal. Thrombolysis was started 3.5 h after symptom onset. At the stroke unit she worsened and repeated CT scan disclosing left temporal and right fronto-basal hematoma. Due to pacemaker MRI was not performed. Cervical and transcranial duplex scan was normal. She was discharged a week later asymptomatic, on triflusal 600 mg/d. Discussion: There is no data on thrombolysis safety in FAP patients. It is known that in some mutations there is an important amyloid